Critical appraisal:Su S, Scott WJ, Allen MS, Darling GE, Decker PA, McKenna RJ, et al 2013

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Critical Appraisal

Article being appraised

Su S, Scott WJ, Allen MS, Darling GE, Decker PA, McKenna RJ, et al. Patterns of survival and recurrence after surgical treatment of early stage non-small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial. J Thorac Cardiovasc Surg 2013 Nov 26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24290575.


Applicable clinical question

Key Facts

Study Design

case-control study

Study aims:

To compare patients who underwent open versus video-assisted thoracoscopic surgery (VATS) resections by propensity-score matched analysis (a post-hoc analysis of a randomised trial of lymph node dissection versus sampling)

Number of Patients:

752

Classified into 5 equal-sized propensity-score groups
Reported outcome(s):

overall survival (5 year and median)
disease-free survival (5 year and median)
locoregional recurrence-free survival (5 year)
distant recurrence-free survival (5 year)

Results of outcome(s):

Overall survival between the VATS and open lobectomy groups were similar - median overall survival for VATS not achieved; 5-year survival was 71.6% (95% CI: 1.3%-83.6%) - median overall survival for open lobectomy was 8.4 years, 5-year survival was 65.9% (95% CI: 62.3%-69.7%) (p= 0.36)
There was no difference in disease-free survival between the 2 groups - 13 (20%) patients in the VATS who had a recurrence and 193 (28%) patients in the open group
No difference in 5-year disease-free survival -75.2%in the VATS, and 69.2% in the open lobectomy (p= 0.55)
Locoregional recurrence-free survival was similar between the 2 groups - 82.0% in the VATS group and 86.1% in the open lobectomy group (p= 0.58)
Distant recurrence-free survival was also similar between the 2 groups - 87.4%in the VATS group and 75.3% in the open lobectomy group (p= 0.20)

Includes an economic evaluation

no

Evidence ratings

Level of evidence

III-2

Risk of bias
Moderate risk of bias Comments: Large well run trial, albeit for different end point and aim

Risk of bias assessment: case-control study

Subject selection
Cases
Selected group (e.g. multi-institution study)
Adequacy of case definition
Independent validation of outcome (blind to exposure status)
Controls
From same population as cases and same exclusion criteria used
Comparability of groups on demographic characteristics and important potential confounders
Comparable (or matched)
Ascertainment of exposure/treatment
Blinded to case/control status
Follow-up complete and all patients included in the analysis?
Complete response
Size of effect
3 Reason for decision:
Relevance of evidence
1 Additional comments:
Result of appraisal

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Completed by

Associate Professor Gavin Wright MD FRACS PhD


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Article
Su S, Scott WJ, Allen MS, Darling GE, Decker PA, McKenna RJ, et al. Patterns of survival and recurrence after surgical treatment of early stage non-small cell lung carcinoma in the ACOSOG Z0030 (ALLIANCE) trial. J Thorac Cardiovasc Surg 2013 Nov 26 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24290575.
Assigned to
User:Gavin.wright
Topic area
Guidelines:Lung cancer/Treatment/Non-small-cell stage I operable
Clinical question
Form
Form:Critical appraisal


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